Active Surveillance for Prostate Cancer
Overview
Active surveillance means doctors closely watch prostate cancer rather than treating it right away. This method does not involve surgery, radiation, or medication. Regular checkups and tests, such as PSA blood tests and imaging, track any changes. Common reasons to use active surveillance include:
- The tumor is small.
- The cancer is expected to grow slowly.
- The disease is limited to one spot in the prostate.
- There are no signs or symptoms.
This strategy might be suitable for people who have other medical conditions. It can help avoid side effects from treatments when immediate action is not necessary. It is also an option for individuals who value maintaining current sexual, urinary, and bowel function for as long as safely possible.
Reasons for Choosing Active Surveillance
Doctors and patients choose active surveillance to help avoid the side effects of aggressive treatments for prostate cancer when the risk of the cancer getting worse is very low. This approach lets people hold off on surgery or medicine, so they can keep their quality of life for as long as possible.
Situations Where Active Surveillance Applies
- The cancer is small and only in one area of the prostate.
- The Gleason score is 6 or lower, showing the cancer is less aggressive.
- The person has other serious health conditions that lead to a lower life expectancy.
| Condition | Why Active Surveillance is Appropriate |
|---|---|
| Small, early-stage prostate cancer | Cancer is unlikely to spread quickly. |
| Low Gleason score | Growth rate is slow and less risky. |
| Other major health issues | Treatment could be more harmful than the cancer itself. |
By carefully watching the cancer, people can delay or even avoid the side effects of treatment, such as problems with the bladder, bowels, or sexual function. For many patients, this approach also provides time to emotionally process a cancer diagnosis without rushing into invasive procedures.
Possible Complications
Active surveillance for prostate cancer can lead to certain risks and challenges:
- Increased Anxiety: Some people may feel worried or stressed about not starting prostate cancer treatment right away.
- Regular Health Visits: This approach often means more frequent check-ups, blood tests, and other exams.
- Chance of Cancer Growth: While waiting, there is a chance that cancer could grow or spread.
- Reduced Treatment Options: If the cancer does grow, treatment options such as surgery or radiation therapy may become more limited or aggressive.
- Potential Health Problems: Delaying immediate treatment could increase the risk of health problems like erectile dysfunction if cancer advances.
Additionally, the need for repeated biopsies carries its own risks, such as bleeding, infection, or discomfort. Long-term monitoring may also cause emotional fatigue or create uncertainty for some patients.
What You Can Expect
People on active surveillance have scheduled check-ups every few months. At each visit, healthcare providers use several tests to track changes in the prostate and the progress of cancer.
Common Test Methods
| Test Name | What It Checks | How It’s Done |
|---|---|---|
| Digital rectal examination | Changes in prostate shape/size | Gloved finger inserted into the rectum |
| PSA blood test | Level of prostate-specific antigen | Blood sample taken from the arm |
| Prostate biopsy | Cancer type and growth | Tissue samples collected with a needle |
| MRI Scan/Ultrasound | Prostate images and cancer location | Imaging using sound waves or magnetic fields |
A healthcare provider performs digital rectal exams by gently examining the prostate through the rectum to feel for unusual shapes or growths. Clinicians measure the amount of prostate-specific antigen in the blood with PSA blood tests. Rising PSA levels may suggest cancer is getting larger or more aggressive.
Doctors often use multiparametric MRI or ultrasounds if other results are unclear. These scans produce detailed pictures to help spot any concerning areas inside the prostate. Doctors usually recommend a prostate biopsy about one year after beginning active surveillance.
They sometimes repeat biopsies based on results. Specialists check the collected samples for changes in the Gleason score to determine how likely it is that the cancer will grow. Doctors might suggest other tests, such as molecular tests or genetic tests like those for the BRCA2 gene, in certain cases. Each result guides decisions about whether to continue watching the cancer or start treatment.
Findings
Many people who select active monitoring for prostate cancer do not need further treatment. In many cases, the cancer remains slow-growing and does not cause symptoms. Reasons for moving from active monitoring to treatment may include:
- Faster cancer growth than expected
- Cancer spreading beyond the prostate
- New symptoms appearing
Treatment options include surgery, medications, or radiation, depending on individual risk groups.
Living with Active Surveillance
Active surveillance is not passive—it’s a structured approach that allows people to delay or avoid treatment while staying alert to cancer changes. Maintaining a healthy lifestyle, managing stress, and attending regular checkups are key to long-term success.
Patients should stay in communication with their care team and report any new symptoms or concerns. This strategy balances cancer management with quality of life and may continue for years if the cancer remains stable.
